JBI Levels of Evidence

1 Page | 1 JBI Levels of Evidence Developed by the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party October 2013 PLEASE NOTE: These Levels are intended to be used alongside the supporting document outlining their use. Using Levels of Evidence does not preclude the need for careful reading, critical appraisal and clinical reasoning when applying Evidence . Levels OF Evidence FOR EFFECTIVENESS Level 1 Experimental Designs Level Systematic review of Randomized Controlled Trials (RCTs) Level Systematic review of RCTs and other study designs Level RCT Level Pseudo-RCTs Level 2 Quasi-experimental Designs Level Systematic review of quasi-experimental studies Level Systematic review of quasi-experimental and other lower study designs Level Quasi-experimental prospectively controlled study Level Pre-test post-test or historic/retrospective control group study Page | 2 Level 3 Observational Analytic Designs Level Systematic review of comparable cohort studies Level Systematic review of comparable cohort and other lower study designs Level Cohort study with control group Level Case controlled study Level Observational study without a

2 Control group Level 4 Observational Descriptive Studies Level Systematic review of descriptive studies Level Cross-sectional study Level Case series Level Case study Level 5 Expert Opinion and Bench Research Level Systematic review of expert opinion Level Expert consensus Level Bench research/ single expert opinion Page | 3 Levels OF Evidence FOR DIAGNOSIS Level 1 Studies of Test Accuracy among consecutive patients Level Systematic review of studies of test accuracy among consecutive patients Level Study of test accuracy among consecutive patients Level 2 Studies of Test Accuracy among non-consecutive patients Level Systematic review of studies of test accuracy among non-consecutive patients Level Study of test accuracy among non-consecutive patients Level 3 Diagnostic Case control studies Level Systematic review of diagnostic case control studies Level Diagnostic case-control study Level 4 Diagnostic yield studies Level Systematic review of diagnostic yield studies Level Individual diagnostic yield study Level 5 Expert Opinion and Bench Research Level Systematic review of expert opinion Level Expert consensus Level Bench research/ single expert opinion Page | 4 Levels OF Evidence FOR PROGNOSIS Level 1 Inception Cohort Studies Level Systematic review of inception cohort studies Level Inception cohort study Level 2 Studies of All or

3 None Level Systematic review of all or none studies Level All or none studies Level 3 Cohort studies Level Systematic review of cohort studies (or control arm of RCT) Level Cohort study (or control arm of RCT) Level 4 Case series/Case Controlled/ Historically Controlled studies Level Systematic review of Case series/Case Controlled/ Historically Controlled studies Level Individual Case series/Case Controlled/ Historically Controlled study Level 5 Expert Opinion and Bench Research Level Systematic review of expert opinion Level Expert consensus Level Bench research/ single expert opinion Page | 5 Levels OF Evidence FOR ECONOMIC EVALUATIONS Levels 1. Decision model with assumptions and variables informed by systematic review and tailored to fit the decision making context.

4 2. Systematic review of economic evaluations conducted in a setting similar to the decision makers. 3. Synthesis/review of economic evaluations undertaken in a setting similar to that in which the decision is to be made and which are of high quality (comprehensive and credible measurement of costs and health outcomes, sufficient time period covered, discounting, and sensitivity testing). 4. Economic evaluation of high quality (comprehensive and credible measurement of costs and health outcomes, sufficient time period covered, discounting and sensitivity testing) and conducted in setting similar to the decision making context. 5. Synthesis / review of economic evaluations of moderate and/or poor quality (insufficient coverage of costs and health effects, no discounting, no sensitivity testing, time period covered insufficient).

5 6. Single economic evaluation of moderate or poor quality (see directly above level 5 description of studies). 7. Expert opinion on incremental cost effectives of intervention and comparator. Levels OF Evidence FOR MEANINGFULNESS 1. Qualitative or mixed-methods systematic review 2. Qualitative or mixed-methods synthesis 3. Single qualitative study 4. Systematic review of expert opinion 5. Expert opinion